Healthcare Provider Details

I. General information

NPI: 1366409443
Provider Name (Legal Business Name): MEDIPHARM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 GRAYSTONE PL
CONOVER NC
28613-8200
US

IV. Provider business mailing address

3412 GRAYSTONE PL
CONOVER NC
28613-8200
US

V. Phone/Fax

Practice location:
  • Phone: 828-322-4499
  • Fax: 828-322-7655
Mailing address:
  • Phone: 828-322-4499
  • Fax: 828-322-7655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number5431
License Number StateNC

VIII. Authorized Official

Name: MR. JAMES CHARLES SUAREZ
Title or Position: PRESIDENT
Credential: RPH
Phone: 828-322-4499